=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912902412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAX WEISFELD D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 01/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5508 HARFORD RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21214-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-426-5508
-----------------------------------------------------
Fax | 410-426-4066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5508 HARFORD RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21214-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-426-5508
-----------------------------------------------------
Fax | 410-426-4066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 00400
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------